Living with Pain: Steve McQueen and the Missing ‘P’

Living with Pain: Steve McQueen and the Missing ‘P’

225_mcqueen_VIN_370If only I could quick draw my Colt .45 from my worn leather holster like Steve McQueen and scatter those bastards to the four corners once and for all, I’d never have to write, nor you read, another of these boiling screeds.

We could all move on to more important things.

But apparently, we’re not there yet.

Once again we have a pair of researchers, psychiatrists in this instance, who need a bit of a verbal beating about the head and shoulders.

Recently, the journal General Hospital Psychiatry published the research article, “The Missing ‘P’ in Pain Management,” by Catherine Howe, MD, and Mark Sullivan, MD, who tell us the current “opioid epidemic” highlights the need for psychiatric services in chronic pain care.

To start my discussion, I want first to say that I’m not going to engage in the controversy or the ginned up hysteria over the phrase “opioid epidemic” — other than to say that it in no way captures the broader worldwide epidemic of poorly understood and poorly treated pain.

In all research the investigators make efforts to uncover and explicate their conscious assumptions relative to the topic they investigate. This is a crucial step, as assumptions are the bedrock on which all research is built.

I focus on the following sentence from this study as it captures the problem at its core:

“Common mental disorders, such as depression and anxiety, are known to be associated with higher pain intensity, more pain complaints as well as higher pain interference with daily activities.”

First, does it surprise anyone that psychiatrists would discover that the “Missing P” in pain care just happens to be psychiatry?

Just who benefits from this discovery? Patients?  The advancement of pain research?  Uncovering new methods of treatment? The answers would be yes, yes and yes, if we’re to believe the researcher’s conclusions.

But we really must raise the flag of skepticism.

We must ask all researchers who advance a treatment for any physical or psychological malady who might benefit financially from the discovered advancement.

The “Missing P” answer fairly leaps off the page: Psychiatrists!

The investigators seem to operate from the assumption that the main problem for pain patients are of psychiatric origin, instead of the psychiatric arising from physical pain.

Yes, research has shown that those who suffer from depression and/or anxiety have more complaints of aches and pains.

But what hasn’t adequately been demonstrated is how these two emotional disorders cause the pain from CRPS, diabetes, neuralgia, arachnoiditis, degenerative joint disease and, well, you get the deranged picture.

The above mentioned maladies and many others at the root of chronic pain will cause depression and anxiety in the majority of those who live with those demons. But some of us avoid those pits and how we do it is something that needs investigation.

I wish the researchers had looked in that direction, but these days any proposal with the words “opioid” and “addiction” will attract research dollars, thus the evidence for the ever burgeoning opioid scourge.

When the underbrush of research language is cleared away from this report, we’re faced with the recurring implication that what most troubles pain patients lies in our heads, not in our bodies.

It’s the evils of psychiatric problems that are the genesis of our pain or at the very least the accelerant poured on its flames.

Those of us living in those flames know the flabbiness of that self-serving argument.

Physicians, providers, researchers, and insurers want you to know exactly how this works: First we are in a bit of pain, then a lot of pain, then too much pain to withstand, and then we often declare disability.

What follows is anxiety and depression, which are usually treated by our providers with medicines that help drive off these unwelcome intruders.

This isn’t to say we never need to seek psychotherapeutic assistance. I’m just saying it doesn’t have to be an integral part of our treatment regimen. And that’s coming from someone whose early career was as a psychotherapist.

But sometimes reordering our brain’s chemicals isn’t enough. Sometimes we just need help in the painful process of admitting the horrid intruder into our homes and families.

But here’s a dirty little secret. As we who live with these monsters well know, there are a lot of people making a lot of money treating us: doctors, researchers who gobble up grant money, drug manufacturers, psychiatrists and psychotherapists of all stripes.

Our conditions put a lot of kids through college.

I just get a bit suspicious when a couple of psychiatrists come to the conclusion that our pain problem is largely in our heads and that the “Missing P” is psychiatric treatment for all the pain that anxiety and depression is loading up on us.

I’m not suggesting that these researchers are consciously doing this, but they need to look closely at their assumptions and conclusions.

If, by the way, you do need psychotherapy, find a good clinical social worker trained in the intricacies of relationships. We social workers are, by and large, a pretty empathic lot and we are a far less expensive alternative to psychiatrists who routinely charge over $200 per session.

I’m sick to death of waving my heavy Colt around. My right shoulder has already been surgically repaired twice.

Steve McQueen wants you guys to get it right.

The horrid pain comes first, anxiety and depression next.

Got it?

Mark Maginn

Mark Maginn

Mark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here

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The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Mark - an amazing article. I’ve added a link from my support group website for sufferers of Arachnoiditis

This morning I had a Eureka moment, a doctor actually agreed with me that I DO NOT HAVE any form of mental illness or depression after living with chronic pain for 14 years - what I have is chronic adjustment syndrome. In other words I’m reacting like any other human being living with a chronic illness!

Many thanks x

Rebecca Hoey

Mark, as I just posted when I shared your article; it is the greatest one I have ever read regarding the assumptions made by the medical community and others regarding medical conditions that cause debilitating pain. I know this from the battle I fight for my 14 year old daughter. I can’t thank you enough for writing such an incredible piece!! Thank you!!! Rebecca


Thank you, Mark! I agree 100%. So, according to these bozos, if I have severe chronic (and acute) pain that stems from Ehlers-Danlos Syndrome (a genetic connective tissue disorder), does that mean I really don’t need pain control? How insightful!

Too bad that when my depression is treated, I still have PAIN! I am sick to death of having my pain belittled, or explained away by other causes….

When one of our pets is suffering from debilitating pain from a documented medical condition, do we put them on an anti-depressant & send them home, with the name of a good therapist?

NO. We either try to cure them, or we make them comfortable! If they are suffering too much, we euthanize them. Why? Because its inhumane to let them suffer for a prolonged period.

In the hysteria over opioids, we have decided that it’s OKAY to let people suffer from uncontrolled pain. What’s HUMANE about that? NOTHING!

Mary Allen

AMEN Mark!! Well said!

Well done! You make a well reasoned case with just the right amount of justified outrage. You speak for many, thanks!